Healthcare Provider Details

I. General information

NPI: 1568246379
Provider Name (Legal Business Name): KARRYANN STANLEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/22/2023
Last Update Date: 08/22/2023
Certification Date: 08/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 N BENT ST
POWELL WY
82435-2336
US

IV. Provider business mailing address

PO BOX 1296
POWELL WY
82435-1296
US

V. Phone/Fax

Practice location:
  • Phone: 307-250-8087
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number176768
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: